P&O vs DME

P&O vs DME

Dear Colleagues,

Here are some replies that I received. We cannot give up people, this is our
profession we are talking about. There are some good responses with info to
get us started. The last response is really interesting.

My original posting:
Dear Colleagues:

I am sure that the following is not only an issue in the state of
Washington,
but it is a national issue. We have now had 2 major insurance companies
pretty much give us a 'NON NEGOTIABLE FEE' policy with regard contract
renewal. We
either accept the fee schedule which is below Medicare, or we loose our
preferred status and will not be able to regain it in the future. (Is this
even
legal I wonder?)

However, the major reason for this attitude, I believe, is because we are
associated with DME and we are not seen as the professionals that we are.
Every
other specialty within the realm of Rehabilitation Medicine is seen as a
professional and not DME although they do treat patients with Orthotic
devices.

So how do we tackle this issue? Our national associations should have taken
care of this issue many moons ago and maybe they have tried unsuccessfully,
but we need to change this DME stigma if we want to see longevity of our
profession. We are putting so much effort into raising the standard of
education,
introducing residency programs, licensing in many states, etc., and I am all
for
that. But what is the point if our profession is categorized as VENDORS!

We need to come together as a profession and employ a lobbyist,
representative, I have no idea who can take care of this for us, but we need
to get
ourselves deforced from DME. My company will be the first to pledge funds
for this
purpose. If we all join in we can do this, as we did with licensure.

Lets come up with a solution.

John Hattingh LPO

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John,

This looks like a job for NAAOP. The group is different than AOPA in that
NAAOP represents the political concerns of the O&P professional without
having to be slanted towards the needs of the manufacturers. The NAAOP
membership is made up of practitioners - NOT manufacturers.
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John,
   This is a LOST CAUSE! Sadly, our profession, the work so many of us love,
is being discounted, absorbed, diminished, depreciated, demeaned and
overcome. I would not recommend anyone enter the field of O&P today, thanks to
managed care and the abominably dismal performance of the leadership representing
this profession. Please feel free to post my response.
Steven Fries, LPO
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In my humble opinion the only sound recourse that a responsible O & P
professional has to an unacceptable non-nogotiable contract offer is to WALK AWAY.

Alan Ross, CPO
Suncoast O & P
Sarasota, FL
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FYI
Medicare has separated O & P from DME in regulatory enforcement policies. I
am not sure, but I believe under the new Medicare bill, Medicare will
separate O & P from DME entirely.

Don Dixon, CPO
Center for Orthotic & Prosthetic Care
(919) 967-7133 voice
(919) 967-5360 fax
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From: tony barr < <Email Address Redacted> >
To: < <Email Address Redacted> >
Subject: RE: [OANDP-L] P&O vs DME

John,
My read to your question below is the solution lies in a united front,
presented and available NOW by all O&P professionals, thru joining the
Academy. Start by uniting your badly splintered and divided profession.
With their newly enacted by-laws AAOP can help stop the division that has
occurred for far too many years in the profession. You got to get inside
the system to change the system.

See <URL Redacted>
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John, I think the time of solution came and went in the 1980's. The industry
was focused on selling hardware and ignored what the profession wanted to do
to expand our scope of practice. We were very short signed and now the
profession of O&P is going to pay the price while the industry makes money.

Al
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This is not issue only in the state of Washington, it is everywhere.

One thing that might help you is there is a pending Medicare rule that will
exclude any provider that charges Medicare more than their true average
charge for a service. The amount is defined as 20%, which means that if you
typically accept 17% off Medicare or a greater discount, you are in
violation and can be excluded from all federal programs.

I have seen this rule mentioned in the O&P Almanac and in the New York
Times..a copy of the text from the news article is below. The Almanac
article said this rule was already published in the Federal Register, so I
expect it will be put in place.

My experience so far has been that if I present this rule to the payor, they
will agree to raise their reimbursement so no violation occurs. Of course
this is only an agreement at this point because the rule has not gone into
effect.
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